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F APPLICATION FOR SANITATION PERMIT Permit No..-� (Cornplet& in Duplicate) Date Issued .__- --- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here -in described. This application is made in compliance with County Ordinance No, 549. r JOB ADDRESS AND LOCATION..:: l--_._------ ----"-64 -=-- •----------•------------------•------- ----- Owner's Name .� � Phone ------------------------------------ Address= _t.., .- - --------- -------- ----------------------------••----------------------- -----------------------------•---------------- Contractor's Name-------- ------------ Phase. -- f Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑Motel ❑ Other ❑ J/ l ------------ -------------------- Number of living units: ----!-__ Number of bedrooms .-=YNumber of baths --1---_ Lot size .___ ___._ Water Supply: Public system Community system ❑ PrivatDepth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel V Sandy Loam ElClay;Loam Clay ❑ Adobe ❑ Hardpan El Previous Application Made: Yes ElNo New Construction: Yes � No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ----Distance from foundation---:--�-----.Materai--------------------------------'Q.. + Septic Tank: Distance from nearest well 1 q �} No. of compartments__._.__._.<- ------Size.-__ / Q--`.. --Liquid depth__ --J_.__'_.. Capacity.r►�-__._____,. Disposal Field- Distance from nearest well -fl -4W. Distance from foundatio`�e______ . ------- Distance to nearest lot line Number of lines--------- --�- ---=-----l_..-Length of each line ..... -AQ Width of trench--- -.,-----------•------- Type of filter material=Y..l_ :-Depth of filter material---------- — -----Total length ------- ,�,, -.�._._.Distance to nearest lot line____r_____ See�aage Pit: Distance to nearest well .04& fro Kundfio, d___ _. r� ► Number of pits------ ----------- " `tl-ag:material_��c Diameter_4�±.X_ItQ - Depth-------�----- •------ -------- Cesspool: Distance from nearest well -----------------Distance from --__.-.--___.._._...Lining material -------------- __.____._.___________ ❑-----.Depth_---------•------`------------------ -------:Liquid Capacity ----------------------- gals. -!F- _----- Size: Diameter---------------------------- -- 4.f Privy: Distance from nearest well ----------- ------------------------------------ -Distance from nearest building --------------------------------------- ._. 6� ❑ Distance to nearest lot line ---------------------------- ----------------------------------•----------------------------------------------------------------------------- Remodeling and/or repairing (describe):______________________________________________________ ------------------- • •---------------------- •---- •----------•--------•-------------------•-------- ----- -------------------------- ----------- • -1 ----------------------------------------------------------------------------------------------------------------- ----------------------------- ..---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules ands-6gulations of the San Joaquin Local Health District. _ !_�. -. Owner and/or Contractor !._... --------- ( / I (Signed) BY: (Tiltle _ �. ---------------------- --------- ----------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY --------------------------- --------------------------------------------------------------------- DATE ------------------ ----------------------------------------- . 1.,) BY 4 . --- DATE » *"------------- �" ------ DATE ---------��--• ------`�---- -----------•------------ BUILDING PERMIT ISSUED ---------------------------------------- Alterations -------- ------Alterations and/or recommendations:---------------------------------------------------•-----------•----------------------------I --------•--------------------------•- --------------- --------------- ----------•-------------------•----------••---------------------------------------•-------------------•----------------- ------------------------- ------------------ ......_----------------- ------•------------------------------------------------------------------ FINAL INSPECTION BY: Date... --------t 130 South American Street Stockton, California ES -9 145446 ATWOOD SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California